Healthcare Provider Details

I. General information

NPI: 1225889447
Provider Name (Legal Business Name): VIOLA PECOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 JEFFERSON ST NE
ALBUQUERQUE NM
87109-3473
US

IV. Provider business mailing address

4240 INTERNATIONAL PKWY UNIT 180
CARROLLTON TX
75007-1974
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number6804
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: